Jeffrey Fudin, PharmD, DAIPM, FCCP, FASHP

Dr. Jeff Fudin graduated from Albany College of Pharmacy & Health Sciences with a BS and PharmD. He is a Diplomate to the Academy of Integrative Pain Management, a Fellow to ACCP and ASHP, and a member of several other professional organizations. He is President and Director, Scientific and Clinical Affairs for Remitigate, LLC (remitigate.com), a software platform for interpreting urine drug screens (Urintel) and risk for opioid-induced respiratory depression (Naloxotel). Dr. Fudin is a section editor for Pain Medicine and serves on the editorial board for Practical Pain Management. He practices as a clinical pharmacy specialist (WOC) and director of PGY-2 pharmacy pain residency programs at the Stratton Veterans Administration Medical Center in Albany, New York and has academic affiliations with Western New England University and Albany Colleges of Pharmacy.

Prescribers and pharmacists in various clinical roles are often challenged when treating patients with comorbid chronic pain and end-stage renal disease (ESRD) or hemodialysis (HD). There is a dearth of clinical guidelines available for chronic pain management in this setting. Those selecting pharmacotherapy for patients must rely on clinical judgement, literature analysis and prudent decision making.

A recent New England Journal of Medicine publication addressed the rising costs of naloxone, but failed to address many of the hidden issue that are buried within routine pharmacy practice. Here we unveil some of the less obvious reasons and offer software solutions to help pharmacists safe lives.

Buprenorphine is one of the most commonly prescribed medications to treat opioid addiction. In 2014, about 60-65% of Americans using medication-assisted treatment received buprenorphine. On July 6, 2016, the Department of Health and Human Services (HHS) announced that it will raise the limit on the number of patients that can receive the addiction medicine buprenorphine to 275 patients per qualified provider. This article describes potential monetary conflicts in proving buprenorphine, how increased access will affect pharmacists and what they can do to help patients in need of medication supported abstinence and substance abuse counseling.

It is compulsory for pharmacists to counsel all patients receiving opioids, evaluate the potential benefit of a naloxone reversal device, and contact the opioid prescriber if such a device is deemed appropriate.

In response to the recent article by Gary M. Franklin, MD, MPH, titled "Opioids for chronic non-cancer pain: A position paper of the American Academy of Neurology," we wish to address a number of issues.